The Indian Journal of Pediatrics (April 2020) 87(4):253–254
https://doi.org/10.1007/s12098-020-03229-8
EDITORIAL COMMENTARY
Insight to Newer Agents and Methods for Local Anesthesia
in Pediatric Dentistry
Vijay Prakash Mathur 1 & Gauri Kalra 2
Received: 29 January 2020 / Accepted: 30 January 2020 / Published online: 8 February 2020
# Dr. K C Chaudhuri Foundation 2020
Local anesthetics are being used in various forms for topical
use and are used for anesthesia, pain relief and for diagnostic
purposes. Many of these salts have similar chemical struc-
tures, and somewhat different pharmacokinetic properties
and variable pharmacodynamic effects. All these influence
the selection of agents for use in various clinical situations.
In the article, titled Comparison of 0.5% centbucridine and
2% lignocaine as local anesthetic agents for dental procedures
in children: a randomised controlled trial published in current
issue of IJP, the authors have addressed the limited application
of centbucridine as a local anesthetic agent in pediatric den-
tistry [1]. The literature is factually scarce in this field even
though centbucridine being shown as superior over
Lignocaine. The article highlights the superior properties of
Centbucridine such as anti-allergic properties and anti-
histaminic properties, though the results obtained in the clin-
ical trial are not significant [1].
It has been a well-established fact that younger children
experience pain and discomfort due to dental infections, inju-
ries and dental procedures [2]. The newer salts available,
which are little structurally different to lignocaine, are
levobupivacaine, ropivacaine, and articaine [3]. These newer
salts are found to be having equal or more efficacy, faster onset
of action and longer duration. However, the research is in
progress and we may see them as products in the market in
coming years. Some of the adjuvants like bicarbonates and
steroids have also been tried to improve the efficacy/
duration of action of local anaesthetics in dentistry. The
* Vijay Prakash Mathur
vijaymathur7@yahoo.com
1
Division of Pedodontics and Preventive Dentistry, Centre for Dental
Education and Research, WHO Collaborating Centre for Oral Health
Promotion, All India Institute of Medical Sciences, New
Delhi 110029, India
2
Department of Pedodontics and Preventive Dentistry, Sudha Rustogi
Dental College, Faridabad, Haryana, India
centrbucridine salt has been developed by an academic insti-
tute in India and it is expected that it is not likely to be very
expensive or maybe equally efficacious.
The clinicians treating children also face a challenge in
terms fear of injection or complex instruments. In order to
overcome such challenges, newer methods of local anesthesia
delivery systems have come into market and it is worthwhile
to enumerate them here.
& Computer controlled local anesthesia delivery (CCLAD)
system: This advanced system injects local anesthetic
agent into the tissues at a set slow speed and also takes
into account the anatomical features of the site being
injected. Baghlaf et al. and Mittal et al. has reported
CCLAD to be advantageous in delivering anesthesia in
young patients [4, 5].
& Jet Injections: Such system allows the liquid local anes-
thetic agent to be deposited subcutaneously through the
mechanism of mechanical energy though without the use
of syringes. It works well in needle phobic young and
adult patients. Munshi et al. found a significant acceptance
to application of MADAJET XL system over traditional
syringes in 3–13 y old children [6].
& Topical Anesthesia: Topical/ local application of local an-
esthetic agents in gel or cream form have been extensively
used in performing dental treatment in pediatric dentistry.
Eutectic mixtures for LA (EMLA) have lower melting
points and are thoroughly absorbed in the oral mucosa,
majorly available as 2.5% prilocaine and lignocaine in
1:1 ratio. Intranasal sprays as a 3% tetracaine hydrochlo-
ride and 0.05% oxymetazoline mixture are also available
and mainly used to anesthetize upper front teeth.
& LASER Analgesia: Application of LASER is a newer
method of reducing pain, though it does not provide com-
plete analgesia but causes alterations in the sodium-
potassium pump, thereby disrupting the impulse conduc-
tion to brain temporarily. Soft tissue procedures such as
tongue tie removal or treating high frenum attachments
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may be performed with ease without injecting local anes-
thesia [7].
To conclude, newer local anesthetic delivery systems are
the cornerstones of current evidence based pediatric dental
practice. Incorporation of such devices not only helps in pro-
viding painless dental treatment to young children but also
helps in instilling a positive attitude towards dental treatments
and oral hygiene.
Compliance with Ethical Standards
Conflict of Interest None.
References
1. Comparison of 0.5% centbucridine and 2% lignocaine as local anes-
thetic agents for dental procedures in children: a randomised con-
trolled trial. Indian J Pediatr. 2020. https://doi.org/10.1007/s12098-
019-03161-6 .
Indian J Pediatr (April 2020) 87(4):253–254
2. Pain Management in Infants, Children, Adolescents and Individuals
with Special Health Care Needs. Available at: https://www.aapd.org/
globalassets/media/policies_guidelines/ bp_pain.pdf. Accessed 27th
December 2019.
3. Shipton EA. New formulations of local anaesthetics- part I.
Anesthesiol Res Pract. 2012;2012: Article ID 546409.
4. Baghlaf K, Alamoudi N, Elashiry E, Farsi N, El Derwi DA, Abdullah
AM. The pain-related behavior and pain perception associated with
computerized anesthesia in pulpotomies of mandibular primary mo-
lars: a randomized controlled trial. Quintessence Int. 2015;46:799–
806.
5. Mittal M, Kumar A, Srivastava D, Sharma P, Sharma S. Pain per-
ception: computerized versus traditional local anesthesia in pediatric
patients. J Clin Pediatr Dentistry. 2015;39:470–4.
6. Munshi AK, Hegde A, Bashir N. Clinical evaluation of the efficacy
of anesthesia and patient preference using the needle-less jet syringe
in pediatric dental practice. J Clin Pediatr Dentistry. 2001;25:131–6.
7. Kulkarni N, Parakh A, Modi S, Mankare A, Vanjari G, Fernandes G.
Painless anaesthesia in pediatric dentistry: an updated review. IOSR J
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